Original article—alimentary tract
Relationships Between Disease Activity and Serum and Fecal Biomarkers in Patients With Crohn's Disease

Presented in part at the 108th Annual Meeting of the American Gastroenterological Association, May 19–24, 2007, Washington, DC.
https://doi.org/10.1016/j.cgh.2008.06.010Get rights and content

Background & Aims

The quantitative relationships between instruments and assays that measure clinical, endoscopic, and biologic disease activity in patients with Crohn's disease are poorly characterized. This study evaluated the correlations between the Crohn's Disease Activity Index (CDAI), the Simple Endoscopic Score for Crohn's Disease (SES-CD), serum high-sensitivity C-reactive protein (hsCRP) (both phenotype and genotype) and interleukin-6 (IL-6), and fecal calprotectin and lactoferrin.

Methods

A total of 164 patients with Crohn's disease undergoing colonoscopy were enrolled. The CDAI and SES-CD scores, serum hsCRP and IL-6, CRP and IL-6 genotypes, and fecal calprotectin and lactoferrin were measured.

Results

There were no significant associations between the CDAI and SES-CD scores (Spearman rank correlation coefficient, 0.15) or between the CDAI scores and the serum concentrations of hsCRP and IL-6, or the fecal concentrations of calprotectin and lactoferrin. In contrast, the serum hsCRP and IL-6 concentrations and the fecal calprotectin and lactoferrin concentrations were significantly higher in patients with more severe endoscopic disease activity (SES-CD score > 7 points) (P < .001 for all comparisons). The CRP 717 mutant homozygote and heterozygote status was associated with significantly lower concentrations of hsCRP (P = .02). There was a trend toward higher hsCRP concentrations in the CRP 286 heterozygous adenine mutant-type mutant genotype, but this did not reach statistical significance.

Conclusions

Serum and fecal biomarker concentrations are associated with endoscopic but not clinical disease activity in patients with Crohn's disease. Stimulated hsCRP concentration is affected significantly by select genetic polymorphisms.

Section snippets

Patient Population

This study was conducted at 2 tertiary care centers between November 2004 and November 2006. The protocol was approved by the institutional review board at each center. All patients gave written consent. Eligible patients were adults with an established diagnosis of Crohn's disease involving the ileum, colon, or both, who were undergoing a clinically indicated ileocolonoscopy for either assessment of disease activity or for dysplasia screening after a prolonged duration of colonic disease.

Patients

A total of 180 patients were screened for potential enrollment in the study, of whom 164 met the inclusion and exclusion criteria and were enrolled. The demographic characteristics of the patients are shown in Table 1.

The mean age of the patients was 41 years and the mean duration of disease was 12 years. Fifty-nine percent of the patients were female and 16% were current smokers. The majority of patients had ileocolonic disease (Table 2). Twenty-three percent of patients were receiving

Discussion

This study evaluated the relationship between serum and fecal biomarkers and endoscopic and clinical estimates of Crohn's disease activity. The results show that select serologic and fecal biomarkers are associated positively with endoscopic estimates of Crohn's disease activity (SES-CD), and confirm previous observations of inconsistencies between clinical and endoscopic estimates of disease activity. The results also confirm the hypothesis that selected SNPs of the CRP or CRP promoter genes

References (42)

  • J.A. Tibble et al.

    Use of surrogate markers of inflammation and Rome criteria to distinguish organic from nonorganic intestinal disease

    Gastroenterology

    (2002)
  • J. Wolford et al.

    A C-reactive polymorphism is associated with type 2 diabetes in Pima Indians

    Mol Genet Metab

    (2003)
  • J.A. Tibble et al.

    Surrogate markers of intestinal inflammation are predictive of relapse in patients with inflammatory bowel disease

    Gastroenterology

    (2000)
  • J. Mary et al.

    Development and validation of an endoscopic index of the severity for Crohn's disease: a prospective multicenter study

    Gut

    (1989)
  • G. D'Haens et al.

    Endoscopic healing after infliximab treatment for Crohn's disease provides a longer time to relapse

    Gastroenterology

    (2002)
  • D. Desai et al.

    Review article: biological activity markers in inflammatory bowel disease

    Aliment Pharmacol Ther

    (2007)
  • J. Volkanis

    Human C-reactive protein: expression, structure and function

    Mol Immunol

    (2001)
  • M. Boirivant et al.

    The clinical significance of serum C reactive protein levels in Crohn's disease

    J Clin Gastroenterol

    (1988)
  • C. Andre et al.

    Assessment of appropriate laboratory measurements to supplement the Crohn's disease activity index

    Gut

    (1981)
  • N. Buckell et al.

    Measurement of serum proteins during attacks of ulcerative colitis as a guide to patient management

    Gut

    (1979)
  • C. Brignola et al.

    Importance of laboratory parameters in the evaluation of Crohn's disease activity

    J Clin Gastroenterol

    (1986)
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    Previously published in abstract form in Gastroenterology 2007;132(Suppl 2):A-M1101.

    Supported by Celltech (now UCB Pharma) and the Mayo Foundation for Medical Education and Research.

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